Interpreting Outcomes in DCDD Liver Transplantation: First Report of the Multicenter IDOL Consortium. Issue 5 (May 2017)

• Record Type: Journal Article
• Authors: Goldberg, David S.; Karp, Seth J.; McCauley, Maureen E.; Markmann, James F.; Croome, Kristopher P.; Taner, C. Burcin; Heimbach, Julie K.; Leise, Michael D.; Fryer, Jonathan P.; Bohorquez, Humberto E.; Cohen, Ari J.; Gilroy, Richard K.; Kumer, Sean C.; Foley, David P.; Karim, Aos S.; Hernandez-Alejandro, Roberto; Levstik, Mark A.; Abt, Peter L.
• Is Part Of: Transplantation. Volume 101:Issue 5(2017)
• Publication Date: 2017-05
• Subjects: Transplantation of organs, tissues, etc -- Periodicals; Transplantation immunology -- Periodicals; 617.95
• DOI: 10.1097/TP.0000000000001656
• Languages: English
• ISSNs: 0041-1337

Abstract

Abstract : Background: In the United States, 5% of adult liver transplant recipients receive a graft donation after circulatory determination of death (DCDD). Concerns for ischemic cholangiopathy (IC), a disease of diffuse intrahepatic stricturing limits broader DCDD use. Single-center reports demonstrate large variation in outcomes. Methods: Retrospective deidentified data collected between 2005 and 2013 were entered electronically by 10 centers via a Research Electronic Data Capture database. Our primary outcome was development of intrahepatic biliary strictures consistent with IC. Results: Within 6 months post-DCDD transplant, 162 (21.8%) patients developed a biliary stricture, of which 88 (11.8%) exhibited intrahepatic structuring consistent with IC. Unadjusted 6-month IC rate among the 10 centers varied significantly ( P = 0.006) from 6.3% to 25.9%. The only factor associated with increased risk of IC within 6 months was Roux-en-Y hepaticojejunostomy (vs duct-to-duct) (odds ratio, 3.06; 95% confidence interval, 1.52-6.16; P = 0.002). Graft failure by 6 months was more than 3 times higher for DCDD recipients with IC (odds ratio for IC, 3.36; 95% confidence interval, 1.95-5.79). Conclusions: This first report of the large combined experience with DCDD from the Improving DCDD Outcomes in Liver Transplant consortium demonstrates significant differences in IC among centers, the importance of biliary strictures as a risk factor for graft failure, and does not validate other risk factors for IC found in smaller studies. Abstract : This large series of transplants for donation after cardiac death livers was collected in a multi-center consortium. The use of Roux Y biliary reconstruction was strongly associated with the development of biliary stricture. Large variability due to center effects was noted, suggesting best practices need further dissemination within the consortium.